Vascular Anatomy of Genital Skin and the Urethra: Implications for Urethral Reconstruction

Abstract

An intimate knowledge of the penile skin blood supply is essential to successfully mobilize and construct a fasciocutaneous onlay flap for “substitution” urethral reconstruction. For successful anastomotic urethroplasty, an intact and adequate dual urethral arterial blood supply is essential. The key vascular feature of the urethra and the reason that it can be mobilized extensively and divided is its unique bipedal blood supply. The proximal and distal ends of the urethra are supplied by two arterial blood supplies, the proximal urethra in an antegrade fashion and the distal, retrograde. The common penile artery, a branch of the internal pudendal, first branches into the bulbar and circumflex cavernosal arteries (supplying the proximal corpus spongiosum) and then bifurcates into the central cavernosal arteries and into the dorsal artery of the penis. The dorsal artery arborizes and penetrates into the glans penis and then flows retrograde into the spongiosum. Thus, the corpus spongiosum has two blood supplies, proximally, the bulbar and circumflex arteries and distally, arborizations of the dorsal penile artery.